Walk Softly and Carry a Global Strategy

April 10, 2013
“The computer is the network” goes the famous Sun Microsystems advertising tagline; some consider it one of the smartest marketing slogans ever conceived, because it actually has meaning. Put simply, the phrase implies that all of a network's resources are available on the user's computer to the point they appear to be part of the user's desktop.

When Microsoft expanded its empire into the healthcare IT realm a few years ago, the company evinced more than a few skeptical reactions. But the software giant, headquartered in Redmond, Wash., has employed a deliberate strategy, focusing on two products that address critical needs in today's industry: Amalga, a third-party aggregation solution designed to create a unified view of patient data, and HealthVault, a personal health record.

And at a time when the healthcare IT industry is heating up, Microsoft has increased its presence further, cultivating a partnership with the Atlanta-based Eclipsys Corp., and acquiring the Andover, Mass.-Based software provider Sentillion earlier this year.

Bill Crounse

The company is making statements, and people are taking notice.

“Microsoft's a marketing machine. Besides being one of the early pioneers in the high-tech industry, they're very good about messaging,” says Jeremy Bikman, executive vice president of research and strategy at the Orem, Utah-based KLAS. And the message, he says, is that Microsoft is here to stay.

Driving the IT strategy for the organization is the Microsoft Health Solutions Group, which has grown in spades since its inception in 2005, opening research and development centers in several cities, both domestically and internationally. It has acquired six companies in five years and has grown to about 700 employees.

The company's big splash came in 2006 with the purchase of health intelligence software firm Azyxxi - a move that raised many eyebrows, he notes. “When Microsoft made its move into healthcare space, we got a lot of calls about it. So we made some calls, and we found that about half of the people were pretty excited and thought Microsoft could maybe shake things up, and the other half seemed to think that it was just the latest in a long line of vendors that have tried to get in the healthcare space, and they wouldn't last.”

Jeremy Bikman

But Microsoft has indeed lasted, and has become one of the most compelling companies in healthcare IT (as evidenced by the voting of Healthcare Informatics' readers). And while some may point to the enormous pool of resources the company draws from, those on the inside attest that the key to its success has been a willingness to take risks.

“As we've thought about investing more and more in healthcare, the way we think is, how can we do things differently and solve some of the common challenges in a new way, rather than marching down well-worn paths,” says Nate McLemore, general manager of business development and policy for Microsoft Health Solutions Group. “I think a good example of that is Amalga. We've taken a different data architecture, pulled that data together, and allowed for future innovation.”

The products

The Microsoft Amalga Unified Intelligence System (the new version of Azyxxi) is an enterprise platform designed to retrieve data from disparate sources - including scanned documents, lab and imaging results, and patient demographics - and display it in a centralized location. Originally developed by researchers at Washington Hospital Center in 1996, the product provides a “central warehouse for deep data analysis that can be sliced and diced to drive continuous improvements in quality of patient care and operations,” according to a report published by KLAS (“Beyond the CIS: Why are hospitals buying aggregation solutions?”). Geared toward large integrated delivery networks, Amalga is live at a number of hospitals and health systems, including The Johns Hopkins Hospital, New York Presbyterian Hospital, and MedStar Health group.

With the Amalga solution, Microsoft aims to meet the growing need to present data in an effective and timely manner, and to help providers meet ever-changing critical reporting requirements, says the KLAS report.

That goal goes hand-in-hand with the company's overall strategy in healthcare IT, according to Bill Crounse, M.D., senior director for worldwide health at Microsoft. “It's really a three-pronged approach: we need to liberate data from silos; we need to connect all the various healthcare players in the ecosystem of care; and finally, we need to give people intuitive, affordable tools that they can use to manage the vast amounts of data. I think that's a sweet spot for a company, and I think that's evident in the work we're doing with Amalga.”

However, while the solution certainly shows promise, it's still too early in the game to get an accurate read on how it will fare long-term, says Bikman. “So far, people are excited at what they're seeing, but we haven't found enough hospitals that are advanced enough in their use for us to be able to rate.” And while he feels that a lot of the attention Amalga is attracted can be attributed to high-profile users like Johns Hopkins and the Mayo Clinic, the other “wow factor” is its unique paradigm. “That's probably why it's so intriguing. From what we can tell, it's getting good results from people being able to view data they couldn't view before. But we'll see what happens as we learn more about it.”

As we've thought about investing more and more in healthcare, the way we think is, how can we…solve some of the common challenges in a new way, rather than marching down well-worn paths.-Nate McLemore, Microsoft Health Solutions Group

One factor that could become a driving force in Amalga's growth is the red-hot health information exchange (HIE) market. According to McLemore, the platform currently supports HIEs in Wisconsin, Hawaii and Washington, D.C., and the company sees potential for expansion. “Amalga offers a way to pull the data sets residing within different institutions on different systems together, and create comprehensive views for caregivers, which in turn can improve the delivery of care.”

However, because of its hefty price tag, Microsoft's solution isn't ideal for all HIEs, says Bikman. For those organizations that want to be able to replicate data and perform analytics - which he says is the goal of most HIEs - Amalga may be a more compelling choice than a portal that features a federated model. But for the exchanges that lack funding or tech savvy, a portal that allows users to simply view results might be the best option. “Where Microsoft can make a statement is to use information to advance data analytics and be able to do querying and quality improvement and share disease management data within an exchange area,” he says. “Right now, the companies that have had the most success have been Medicity, Axolotl and others that offer more of a portal approach and a lighter footprint and the ability to get in faster. But that typically means you can do less.”

Where Microsoft can really flex its muscles, says Bikman, is in tying the HealthVault platform to HIEs, which adds another layer of interoperability. Most health exchanges will eventually look to connect with PHRs, so by offering this function upfront, Microsoft can get ahead of the game, he says. “They have a lot of these pieces that seem to be kind of on the cutting edge of where healthcare seems to want to go.”

The consumer health piece is a key part of the company's vision, according to McLemore, who says HealthVault can help engage patients in their own care while also providing the infrastructure to allow them to aggregate their data. A number of organizations, including the American Cancer Society and the American Heart Association, have configured their portals to be compatible with HealthVault.

Some have taken it a step further. At NewYork-Presbyterian Healthcare System, patients can go through the portal (http://myNYP.org) and preregister with their HealthVault account so that upon discharge, they can obtain a summary, says McLemore. This way, patients have a portable record that they can take with them when they go back to the referring physician.

As meaningful use definitions move closer to becoming finalized, and more emphasis is placed on directly engaging patients, Microsoft sees enormous opportunity for solutions that enable patients to quickly and easily access their data. “We're hoping that will drive more providers to connect to solutions like HealthVault to help better engage patients,” says McLemore. “If we just have providers sharing information among themselves, it's a huge missed opportunity.”

A targeted strategy in healthcare

With Amalga and HealthVault, Microsoft offers two products designed to meet specific needs in the healthcare IT space; however, competing in what has become a very crowded industry requires a little more. With that in mind, the software company bought Sentillion, a company specializing in identity and access management, this past February. Sentillion's solutions enable clinicians to access multiple applications within the context of an individual patient using single sign-on technology. “It lets users leverage more out of existing systems by moving quickly between applications, which allows for better workflow,” says McLemore.

By adding a “well-recognized, successful” vendor like Sentillion, Microsoft can potentially build its credibility in the industry, according to Bikman, who sees many similarities between the two companies. “They're somewhat similar in their make-up and customer base,” he notes, adding that both seem to focus on large health systems and hospitals. “But as to how Microsoft is going to leverage the acquisition to improve its current technology, we don't know.” The key to a successful acquisition, he says, is in utilizing newly-gained resources to augment products and services, and not just to beef up balance sheets.

The same goes for successful partnerships, which is what Microsoft had in mind when it teamed up with Eclipsys earlier this year. The goal was to integrate key components of Eclipsys' Sunrise Enterprise suite with Amalga to offer a complete view of each patient by aggregating data from multiple clinical and financial solutions and feeding it into Sunrise, says McLemore.

“A lot of hospitals are running multiple information systems, and the challenge with that is it's very difficult to get a comprehensive view of any given patient,” he says. “What Amalga does is combine all of that data into a common database, and Eclipsys is then able to leverage that data to enhance its applications.” This, he says, can create a more flexible IT environment that can lead to improved workflows.

Through its alliances with well-established vendors, Microsoft is looking not just to build its line of products - Amalga, in particular - but also to encourage a new way of thinking among the vendor community. “For far too long, traditional health IT vendors have had this very closed strategy where once they sell into a hospital, the CIO is sort of held captive to that vendor, and has to keep buying their modules or applications in order to be successful,” notes McLemore. “What we hope to do with Amalga is have an open application environment where different applications can flourish.”

It creates an interesting scenario, says Bikman, where Microsoft can partner with other companies while also competing with them. “It's something very different from what we usually see.”

And it certainly isn't the only factor that distinguishes Microsoft from other companies. Because of its size and profile, the company is able to take some risks that smaller vendors might shy away from. To Microsoft, this may be its biggest advantage when it comes to competing in the healthcare IT space. “We're able to invest to solve challenges on a global scale, which can benefit everybody,” says Crounse. “It's going to take global companies that have the resources and capability to change the industry and bring forward the tools and technologies that are needed.”

Statements like this should come as no surprise - Microsoft didn't reach its level of global success by setting its sights low. But in the world of healthcare IT, the software giant is still a relatively new entity, and it remains to be seen how it will fare against the institutions that have been churning out applications for decades.

“I think peoples' perception has changed with them buying Sentillion, and most people are convinced Microsoft is here to stay. But how successful they're going to be and how good they're going to be is still yet to be determined,” says Bikman. “So far they seem to be living up to a lot of the billing, but it's still pretty early. They're just a couple miles into the marathon.”

Beyond Amalga: Other offerings from the Microsoft Health Solutions Group

Healthcare CIOs, other executives and providers can visit Microsoft's Health ICT Resource Center (http://www.microsoft.com/industry/healthcare/technology/) to access the following tools, along with case studies, webinars, downloads and other offerings:

Connected Health Framework, an architectural blueprint that provides a vendor-agnostic set of best practices based on Services Oriented Architecture to create platforms for health solutions.

MS Health Common User Interface (http://www.mscui.net/), which provides user interface design guidance and toolkit controls that address patient safety concerns.

HealthBlog (http://blogs.msdn.com/healthblog/), a segment in which Bill Crounse, M.D., senior director for Worldwide Health (and a former CIO/CMIO at Overlake Hospital Medical Center in Bellevue, Wash.), discusses how IT can improve HC delivery and services around the world.

House Calls for Healthcare Professionals, a series of articles, audio-casts and videos led by Crounse in which healthcare industry and technology experts cover the latest topics.

Healthcare Informatics 2010 June;27(6):48-52

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